State approves medical marijuana regulations

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Companies hoping to sell marijuana for medical use in Massachusetts will be required to hire an independent lab to test their products for contaminants, such as heavy metals and pesticides, under final rules that regulators approved by unanimous vote Wednesday morning.

The provision is among dozens of changes made by the Department of Public Health to draft rules the agency released in March, after staffers reviewed hundreds of suggestions from advocates on all sides of the contentious issue. The rules previously would have allowed marijuana dispensaries to conduct their own testing.

The revisions also will make it easier for families to get marijuana for sick children.

“We have received over 190 written comments,” Cheryl Bartlett, interim deputy public health commissioner, told the Public Health Council, an appointed body of academics and health advocates, before it voted to adopt the rules. “Our task is to balance access to marijuana with community security and impacts.”

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The Globe reported last month that few credible labs will test marijuana products for contaminants for fear of losing federal government contracts, because medical marijuana is not sanctioned by federal law, according to researchers who study the medical marijuana industry.

The updated rules aim to address this concern by suggesting that staff at these independent labs be required to register with the state, to provide them some measure of legal protection. The rules also establish a framework of standards and independent accreditation for labs testing marijuana.

A number of council members said they were uncomfortable with the offiical term for the dispensaries -- medical marijuana treatment centers -- because the facilities will only be dispensing products and not offering any medical treatments.

They voted to change the official name to registered marijuana dispensaries.

Another key change is that these dispensaries will be allowed to use organic pesticides on their products. Earlier, all pesticides would have been prohibited, but that prompted an outcry from growers who said it is almost impossible to run a large-scale agricultural operation without using some sort of pesticides.

“If there is an infestation and the crop needs to be saved, it needs to be saved, otherwise you are going to lose the whole crop and the whole dispensary is in danger of going down,” Jonathan Napoli, owner of Boston Gardener, a Dudley Square gardening supply shop, said in a recent interview.

Napoli said he intends to apply for a state license to open a medical marijuana dispensary in Boston.

Access to marijuana for children has also been a testy issue, and the new rules propose a couple of significant changes. Patients under age 18 with a “debilitating medical condition” would not have to also have a “life-limiting” illness to be eligible for medical marijuana, as required in the earlier version.

Now, written notice from two physicians will allow such patients to override that provision and use marijuana. Also, the definition for a life-limiting illness has been changed, from one where a young patient has just six months to live, to one where a patient may be expected to live as long as two years. The change, the health department said, was to align the rules with the definition used in palliative care, which treats patients who have life-threatening, though not necessarily terminal, illnesses.

Physicians at Boston Children’s Hospital and other child advocates had urged regulators to prohibit marijuana use for young patients, saying that there is scant evidence that it is safe or effective and that it may prove especially toxic to still-developing brains.

Other patient advocates argued that young patients suffering with debilitating illnesses such as cancer should not be denied relief of their symptoms, including pain.

The final rules retain a provision that would require marijuana dispensaries to use child-proof packaging on all products, especially marijuana-infused brownies, cookies, and candies, which are often used by patients who are unable, or do not want, to smoke.

Boston Children’s Hospital pediatrician Dr. Sharon Levy had urged the state to ensure child-proof packaging because, she said, such sweets would be particularly appealing to children.

“If you are 3 years old, you may not be able to read the warning label,” Levy said in an interview.

In Colorado, which legalized medical marijuana several years ago, there has been a spike in the number of calls to poison control centers about children inadvertently eating these marijuana-laced products, said Dr. George Wang, senior toxicology fellow at the Rocky Mountain Poison and Drug Center.

“A lot of people think [medical marijuana] is benign, but we are seeing kids come to the hospital,” Wang said.

Most of these young patients were treated in the emergency room for extreme sedation, but a few had to be admitted for close observation, he said. None died.

Most businesses carry insurance to cover any harm to customers from their products, but some regulators worried that few insurers would be willing to offer coverage to marijuana dispensaries because the drug is not federally sanctioned.

But the state health department said staffers contacted insurers in other states that have approved medical marijuana sales and “determined that access to coverage should not be a barrier.” So the department’s new rules will require dispensaries to obtain general and product liability coverage.

A state summary of the final rules noted that Massachusetts would be the first state to have such an explicit requirement.